Cardiac resynchronization therapy pacemakers versus defibrillators in older non-ischemic cardiomyopathy patients
Yanting Wang1, Michael S Sharbaugh1, Andrew D Althouse1
1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Insights
For older patients with non-ischemic cardiomyopathy receiving cardiac resynchronization therapy (CRT), adding an implantable cardioverter-defibrillator (ICD) did not improve survival rates compared to CRT alone.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The mortality benefit of implantable cardioverter-defibrillators (ICDs) is debated in non-ischemic cardiomyopathy (NICM) following the DANISH trial.
- Many patients in the DANISH trial received cardiac resynchronization therapy (CRT) devices.
Purpose of the Study:
- To compare survival outcomes between CRT pacemakers (CRT-P) and CRT defibrillators (CRT-D) in elderly NICM patients (≥75 years).
Main Methods:
- A retrospective analysis of 135 NICM patients with CRT devices (42 CRT-P, 93 CRT-D).
- Follow-up to all-cause mortality, with survival compared between groups using adjusted analyses.
Main Results:
- Over a median of 46 months, 54 deaths occurred (40%).
- CRT-P recipients showed similar unadjusted (HR 1.04) and adjusted (HR 0.95) mortality rates compared to CRT-D recipients.
- Survival was not significantly different between the CRT-P and CRT-D groups.
Conclusions:
- In elderly NICM patients undergoing CRT, the addition of ICD therapy does not appear to enhance survival.
- These findings suggest careful consideration of ICD implantation in this specific patient population.
Introduction:
With the recent publication of the negative DANISH trial, the mortality benefit of the implantable cardioverter-defibrillator (ICD) has been put in question in patients with non-ischemic cardiomyopathy (NICM). Because a majority of patients in DANISH receive cardiac resynchronization therapy (CRT) devices, we investigated in the present study the survival of recipients of CRT pacemakers (CRT-P) versus CRT ICDs (CRT-D) in a cohort of older (≥75 years) NICM patients at our institution.
Methods:
A total of 135 NICM patients with CRT device were identified (42 with CRT-P and 93 with CRT-D) and were followed to the endpoint of all-cause mortality. Overall survival was compared between the CRT-P and CRT-D groups with adjustment for differences in baseline characteristics.
Results:
Over a median follow-up of 46 months from the time of CRT device implantation, there were 54 total deaths (40%): 14 in the CRT-P (33%) and 40 in the CRT-D (43%) groups. Overall, CRT-P recipients had similar unadjusted mortality compared to CRT-D recipients (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.56-1.93), and this remained unchanged after adjusting for unbalanced covariates (HR 0.95, 95% CI 0.47-1.89) including left ventricular ejection fraction, used of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and the Charlson comorbidity index.
Conclusion:
Our data support that in older NICM patients with CRT devices, the addition of ICD therapy does not improve survival.
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